CT of the feline skull for head and maxillofacial trauma

Why feline head trauma is a CT question

Skull fractures in cats are usually multiple. In 75 cats with CT-confirmed skull fractures (Knight and Meeson, Journal of Feline Medicine and Surgery), 89% had fractures in multiple bones. The mandible, the upper jaw (maxilla, incisive and nasal bones) and the craniofacial region were most often affected, and 56% had a temporomandibular joint (TMJ) injury. Road traffic accidents were the cause in 89% of cats and were associated with concurrent ophthalmic, neurological and thoracic injuries.

Cats also break their skulls differently from dogs. In 95 cats and 91 dogs with traumatic skull fractures on CT (Amengual-Batle et al., Journal of Veterinary Internal Medicine, 2020), the face and skull base were more often affected in cats, and cats more often had multiple fractures.

Radiography compared with CT

A review for general practitioners (Rizkallal and Lafuente, Journal of Feline Medicine and Surgery, 2020) notes that radiography may help, but some injuries are hard to see because soft tissue and bone superimpose. CT is a more sensitive technique for skull injuries. A cadaver study (Hecht et al., Frontiers in Veterinary Science, 2021) describes CT as the imaging modality of choice for acute head trauma. MRI agreed with CT on the presence or absence of a fracture in 93.5% of assessments overall, but only 87.6% on post-trauma studies.

The same review stresses that the cat must first be stabilised, with assessment of the respiratory, cardiovascular, neurological and ophthalmic systems. Imaging follows once the cat is stable enough for anaesthesia.

Fracture patterns CT should map

Region	What the evidence shows
Mandible	Fractured in 40 of 48 cats (Weichert et al., Veterinary and Comparative Orthopaedics and Traumatology). In 109 cats with mandibular trauma (Evenhuis et al., Frontiers in Veterinary Science, 2025), the symphysis (55.0%), condylar process (49.5%) and mid ramus (48.6%) were most often injured.
TMJ	In 79 cats, 158 joints (Mestrinho et al., Journal of Feline Medicine and Surgery, 2022), injuries were unilateral in 70.9%. The condyle was fractured in 55.7% of joints, and 84.0% of these were intra-articular, with the medial half over-represented. Luxations occurred in 32.9% of cats, 87.0% of them rostrodorsal.
Temporal bone	Fractured in 30.4% of the 79 cats, and associated with road traffic accidents.
Orbit, nasopharynx, zygomatic arch	Fractured in 30, 29 and 12 of 48 cats.
Cranial vault	Associated with neurological signs, especially when depressed, and with death in the first week when fragmented or displaced (Amengual-Batle et al., 2020).

In 36 of 48 cats, the fractures involved two or more functional systems, such as the oral cavity with the nasal airways, or the nasal airways with the orbit and eye. Bilateral TMJ injuries were 13.1 times more likely after high-rise trauma.

The brain

In 14 cats with traumatic brain injury that had head CT within 72 hours of admission (Mann et al., Journal of Feline Medicine and Surgery), findings included:

• lateral ventricle asymmetry or midline shift (42.8%)
• intracranial haemorrhage (35.7%)
• cranial vault fractures (14.2%), all depressed

Intracranial haemorrhage was negatively associated with short- and long-term survival.

Head CT protocol at a glance

CT is the modality of choice for acute head trauma, and it is done once the cat is stable enough for anaesthesia. Because most cats have fractures in several bones, the study should cover the whole skull, including both TMJs and the brain.

What the radiologist looks at

• Displacement. More severe displacement before surgery was associated with poor healing in the mid ramus and coronoid process.
• Palate and pterygoid region. Fractures of the palatine and pterygoid bones and hard palate injuries increased the risk of implant loosening and malocclusion. Internal upper jaw fractures and older age were risk factors for complications.
• The TMJ in detail. Whether a condylar fracture is intra-articular, and the direction of any luxation.
• The cranial vault and brain. Depressed, fragmented or displaced vault fractures and intracranial haemorrhage are linked to neurological signs and survival.

What your report will include

Every Veheri case is read by a radiologist or neurologist, and when you order you can choose Diplomate-only reporting or the full specialist panel. Neurology reporting covers CT and MRI. You can chat directly with the specialist assigned to your case, and a simplified pet owner report helps you explain the findings to the owner.

When you take the report forward:

• Mandibular fractures. Open reduction and internal fixation gave adequate healing more often than maxillomandibular fixation, and persistent malocclusion was less common (9.1% versus 53.9%).
• TMJ luxation. In a study of cats with TMJ luxation (Jung et al., Frontiers in Veterinary Science, 2023), successful reduction was significantly associated with the time from injury to treatment, and concurrent dental and maxillofacial injuries were common.
• MRI may be chosen in selected cases.
• Talking to the owner: in the larger fracture series, 84.9% of the dogs and cats survived the first week, and the authors advise that a skull fracture alone should not be considered a negative prognostic factor. Keep in mind that the brain injury data come from 14 cats, and most of the feline fracture series cited here are retrospective.

What to include when you request a head CT report

• signalment: age, breed and sex
• cause of trauma: road traffic accident, fall from height or animal altercation
• time since injury
• neurological status and any modified Glasgow Coma Scale score
• occlusion and whether the cat can open and close its mouth
• ocular and thoracic findings
• whether surgical planning or a prognosis question is the priority

How Veheri can help

Veheri works with veterinary radiologists and neurologists and reports head CT studies remotely for clinics. For dogs, see CT of the canine temporomandibular joint and CT of the canine skull after head trauma.